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Aquaboss Global Water Summary

Leading manufacturer of proprietary water purification systems, initially targeting the $1.2

billion international dialysis water purification market

Successfully combined superior technology and measured growth strategies to establish

itself as an industry leader in dialysis

Aquaboss systems are installed in more than 35 countries and have been embraced by the

world’s leading dialysis companies, including Fresenius, which uses Lauer equipment in

facilities located in Asia, Europe & Canada

The Aquaboss has a demonstrated track record of increasing

market share in multiple major international markets

Founded by H.G. Lauer in 1989, headquartered in Lörrach, Germany

B. Braun’s Success in Global Markets

• 375 installs

• 14 years

• 31% mkt

• KfH, Fresenius

• Gambro exited due to

B. Braun’s dominance

• 14% mkt

in 2 years

• FMC Canada

• 2010 orders: €950K

• Gambro exited

Canada due to B.

Braun’s dominance

• 90 installs

• 9 years

• 23% mkt

• Chinese

Government

• 27 installs

• 13 years

• 57% mkt

• NKF (largest dialysis

provider in Singapore)

rejected Gambro

(offered a free system)

and Cantel’s attempts

to displace B. Braun

• 29 installs

• 48% mkt

• 10 years

• 22 installs

• 30% mkt

• 11 years

• 14 installs; 21%

mkt; 12 years

• Displaced Gambro

(a Swedish Co.) at

Halmstad Hospital,

Sweden’s primary dialysis

research facility

• 21 installs

• 3% mkt

• 4 years

• Poor performance of distributor; replaced

distributor with in-house sales force in 2009

yielding 123% yoy for 2010 orders

• 1,400+

portable

RO orders

Loyal International Customer Base with Significant Penetration in Each Market

http://en.wikipedia.org/wiki/File:Flag_of_the_United_Kingdom.svg

http://en.wikipedia.org/wiki/File:Flag_of_the_United_States.svg

U.S. Dialysis Market Dynamics

New AAMI water standards introduced in the U.S.

Current water purification systems may require expensive changes in operating processes or

equipment upgrades to comply with the higher water quality standards

Water, utility and labor costs continue to increase

Improved technology reduces operating costs for dialysis providers and produces water with

lower levels of toxins and bacteria, reducing the risk of additional costs related to infection

B. Braun’s competitive position in the U.S.

Higher water quality – lower levels of endotoxins improve patient’s outcome

Stainless steel construction – increased useful life

Lower operating costs, water utilization and risk profile

Smaller footprint – reduces space requirement and construction costs for new facilities

Fewer breakdowns – Redundant RO and pumps reduce breakdowns saving

Hemodialysis

System

By unique & innovative products / reliable service

Dialog+ Hemodialysis

machine system

ADIMEA Real-time Kt/V

monitoring

Streamline Airless

bloodline system

Diacap High quality

dialyzer

SolCart Bic cartridge

machine option

24 Hour Technical & Clinical Support

Modular RO system

Pure/Ultra Pure water

quality

Impulse back washing

Complete heat

disinfection

Water saving

technologies

Dead space free system

concept

All products and related services from one supplier

Dialysis machine equipment

Dialyzers

Streamline bloodlines

SolCart bic concentrates

Service

Training

Pre-treatment equipment

Reverse Osmosis

technology

Ring piping solutions

Planning, consulting

Monitoring software

Media providing centers

Aquaboss Water Treatment System

1. Pre-treatment 2. Reverse Osmosis,

modular system 3. Dead Space

Free Piping

4. Solution

Distribution

Station

5. Remote

Monitoring &

Process

Visualization

Green technology approach in water purification

Reduced usage of

chemicals

Water savings

Energy conservation

3.9 Billion gallons of

municipal quality water

is used each year in the

US for dialysis

treatments alone.

► The system offers improvements in all areas

Water is an essential key factor in modern dialysis!

Clinical data show that contaminants in dialysis water

are contributory factors for acute and chronic problems

as well as severe injuries to hemodialysis patients.1

1: Cannata-Andia, JB, Fernández-Martin, JL. The clinical impact of aluminium overload in renal failure. Nephrol Dial Transplant 17 [Suppl 2]: 9-12, 2002

Usuda, K, Kono, K, Yoshida, Y. The effect of hemodialysis upon serum leves of fluoride. Nephron 75:175-178, 1997

Calderaro, RV, Heller, L. Outbreak of hemolytic reactions associated with chlorine and chloramine residuals in hemodialysis water. Rev Saude Publica 35:481-486, 2001

Yamagami, S, Adachi, T, Sugimura, T, Wada, S, Kishimoto, T, Maekawa, M, Yoshimura, R, Niwa, M, Terano, Y, Shaldon, S. Detection of endotoxin antibody in long-term dialysis patients. Int J Artif Organs

13:205-210, 1990

► Increasing water quality standards

► Increasing trend of water costs

According to a USA TODAY study of 100 municipalities,

the cost of water has doubled over the past 12 years and

in more than a quarter of the locations, even tripled in a

few.2

2: http://www.usatoday.com/story/money/business/2012/09/27/rising-water-rates/1595651/

Why Water Must be Treated

Person on Hemodialysis

Blood is exposed to 360+ liters of

water/week

Dialyzer membrane is thin,

non-selective

Nonfunctioning kidney

Can experience harm or death from

untreated water

Average Person

Drinks 14 liters of water/week

GI tract more selective

Functioning kidney

10 - 14 Liters

350 - 450 Liters

New Standards for WTS Design

Aquaboss Double Stage, Heat Disinfected design

Innovative & Differentiating Technology

Dead space free reverse osmosis design

Dead space free distribution system

Dead space free secondary loop

Dual stage reverse osmosis units

Impulse backwashing

Heat disinfection of complete system

Stainless steel construction

Software interface & central monitoring

Allows chemical free sterilization and

improves water quality – minimizes risks

of patient exposure to harmful chemicals

No dead space is critical to

mitigating the development of

biofilm and limiting bacteria

proliferation

Improves water quality and reduces

water consumption

Improves membrane performance,

water quality and reduces costs

Water Treatment System Components

Temperature Blending Valve

Booster Pump

Sediment, Depth, or Multimedia Filter

Water Softener

Carbon Tanks

Micron Filters

Reverse Osmosis (R.O.)

Flow path, Pipes, and Gauges

•Registration

•Water quality

•Reliability

•Ecological

14

Pre-treatment

Reverse Osmosis

Heat Disinfection

Permeate Distribution

Exemplary installation

Pre-treatment Reverse Osmosis Heat Disinfection Permeate Distribution

15

6

1 Central Sampling station 4 Dual Bank BB Filter

Assembly 7 Fleck 2850 Plumbing Kit 10 Softener Tank

2 Symmons Blending Valve 5 Media Tank Trunk

Assembly 8 Carbon Tank Worker 11 Brine Tank

3 Municipal Boost System 6 Fleck 2850 Tubing

Connection 9 Carbon Tank Polisher

12 Pre-treatment drain

trunk

Installation Kit

Reverse Osmosis Heat Disinfection Pre-treatment Permeate Distribution

The dialysis water purification system

► Patented features

► Available as single or double stage

version (pure/ultra pure fluid)

► Wide range of permeate production

capacities (from 14 up to 120

stations)

► Compact design

► Long lasting/reliable components

► Later upgrades in size and features

possible without restrictions and

major renovations.

17

RoDia II / Double Stage Reverse Osmosis System

17 17 Heat Disinfection Pre-treatment Reverse Osmosis Permeate Distribution

Break tank

The dialysis water purification system/Reverse Osmosis (RO)

Double stage RO


Dead space free design

Complete heat

disinfection

Stainless steel design

Modular and compact

design

A second stage for a maximum of security

Single Stage RO: Reliable

solution for all standard

treatment applications .

option

Double Stage RO: Further reduction of

substances (e.g. nitrate / aluminum) for highest

chemical and microbiological water quality.

Additional water savings/no water loss of 2nd

stage.

Full redundancy in case of system failure. No

need to install a second RO or deionisation.

Innovation and

highest water quality

Cost effectiveness

and flexibility


Higher permeate quality and reduced water consumption

Conventional technology technology

Aquaboss® impulse backwashing function minimizes deposits on the

membrane for higher permeate quality and reduced water consumption.

Double stage RO


Dead space free

design

Complete heat

disinfection


Modular and compact

design

Innovation and


Cost effectiveness

and flexibility

The dialysis water purification system/Reverse Osmosis

Prevent biofilm


Dead spaces between the outside of the

spiral wound membrane and the inside of the

pressure vessel.

► Bacterial growth/left chemicals

Dead space free membrane module. Space

between the outside of the spiral wound

membrane and the inside of the pressure

vessel is flushed continuously.

► High permeate quality

► Increase membrane lifetime

Double stage RO


Dead space free

design

Complete heat

disinfection


Modular and compact

design

Innovation and


Cost effectiveness

and flexibility

The dialysis water purification system/Ring Piping

Dead space free Secondary Ring Piping

Double stage RO


Dead space free

design

Complete heat

disinfection


Modular and compact

design

Innovation and


Cost effectiveness

and flexibility


Patented Bernoulli principle valve enables constant

flow also in hose connection to machine.

Dialog+ machine connection right at secondary ring.

Stagnant permeate triggers the

proliferation of a biofilm.

Risk of retrograde ring

contamination.


Hot disinfection from the break tank up to the point of use

► Only the technology incorporates the RO membrane in the heat

disinfection cycle.

► RO heat and ring piping disinfection can be integrated with Dialog+ central heat

disinfection. real system disinfection without dead spots.

► No stagnant permeate (like in conventional tank systems)

Double stage RO


Dead space free

design

Complete heat

disinfection


Modular and compact

design

Innovation and


Cost effectiveness

and flexibility

23

Flow Through Heater

Control Unit Description

Hot Rinse Smart

23 23 Pre-treatment Reverse Osmosis Heat Disinfection Permeate Distribution


Hot Rinse Smart | Heat on demand by flow through heater

► Dead space free, no tank.

► Permeate heat up only on demand. No constant heating of big water tank reservoir.

► > 80°C can be achieved on first and second RO stage.

► Disinfection of the raw water break tank included.

Double stage RO


Dead space free

design

Complete heat

disinfection


Modular and compact

design

Innovation and


Cost effectiveness

and flexibility Energy cost savings

more than 90% (compared to conventional tank system)


Extremely reliable / outstanding long life cycle

Also sampling ports are stainless

steel – integrated in sanitation

process.

Stainless steel offers many advantages:

Long lasting quality

Smooth surfaces that prevent bacterial

growth

Double stage RO


Dead space free

design

Complete heat

disinfection


Modular and compact

design

Innovation and


Cost effectiveness

and flexibility


Easy to expand system capacity and features

Double stage RO


Dead space free

design

Complete heat

disinfection


Modular and compact

design

Innovation and


Cost effectiveness

and flexibility

Single stage RO

with basic

production

capacity

► 1 membrane

modules

► 2 pumps in

standard

config.



Double stage RO


Dead space free

design

Complete heat

disinfection


Modular and compact

design

Innovation and


Cost effectiveness

and flexibility

Single stage RO

with extended

permeate

production

capacity.

► + 2

membrane

modules



Double stage RO


Dead space free

design

Complete heat

disinfection


Modular and compact

design

Innovation and


Cost effectiveness

and flexibility

Extended

ground module

for further

extension.



Double stage RO


Dead space free

design

Complete heat

disinfection


Modular and compact

design

Innovation and


Cost effectiveness

and flexibility

Double stage

RO

► 3 pumps


Double stage

RO with

maximum

permeate

production

capacity.

► 6 membrane

modules for

production

capacity up

to 3.600 l per

hour.


Double stage RO


Dead space free

design

Complete heat

disinfection


Modular and compact

design

Innovation and


Cost effectiveness

and flexibility

Easy installation in existing centers and de novo clinics.

The reduced water consumption reduce the size and cost of pre-

treatment equipment!


Double stage RO


Dead space free

design

Complete heat

disinfection


Modular and compact

design

Innovation and


Cost effectiveness

and flexibility

32

Aquaboss® Reverse Osmosis

Secondary loop | Differential pressure valves

Aquaboss® Stainless steel bulb for

PEX

Aquaboss® Stainless steel bulb for Orbital

Welding

33 33 33 Heat Disinfection Pre-treatment Reverse Osmosis

The Aquaboss® MPC in-wall media providing centre has been developed according to the latest ergonomic and hygienic aspects.

The MPC-FW comprises all required fluid part interfaces to the dialysis unit and all modules for an up-to-date medical care of the patient for

the hygienic provision of all liquid media.

Media Providing Center (MPC)


Permeate Water Outlet Backing Plate for box

reinforcement

HD Machine Drain

Connection

Up to 3 Acid Concentrate

Connections

Molded Concentrate Block for

even flow and pressure

34 34 34 Heat Disinfection Pre-treatment Reverse Osmosis

Secondary Ring Piping (and Insulation)


Secondary Ring –Main connections for the HD

machine. Using the distribution bulb, dead-space

between the main distribution line and HD machine are

eliminated.

•Comes with 316L Stainless Steel female connector

•Comes in lengths of 3,000mm to 7,000mm

EMERGENCY OPERATION OF EcoRO Dia I/II

Emergency Mode provides peace of mind with continuous operation of the

Aquaboss EcoRO for any type of malfunction until the problem can be resolved.

The Aquaboss EcoRO will continue to supply purified water to the permeate loop if

at minimum, AC input voltage and the pre-treated water supply are available.

If any pump or a complete RO stage including a membrane fails, the system can be

quickly switched to resume operation by another motor or stage.

If the CPU fails, the RO will continue to run using relays without any User

intervention. Conductivity and temperature are still monitored independently.

If a DC power supply failure occurs, a back-up DC power supply is available on all

systems.

For all of the cases stated above, the device will generate an alarm and display

instructions to the User for how to activate the necessary Emergency mode.

Used in combination with thermal distribution loop

disinfection.

Activated manually or may be programmed to work at

designated dates and times

Heated water enters the machine at a specified rate

and time

End to End Thermal Disinfection

24%

25%

24%

27%

The system Technology that reduces the total cost of ownership

Assumptions:

76 patients and 12,000 treatments per year, 210 liters permeate per dialysis

treatment, 15 years operating life, Water costs: € 2.57/m3

Capital costs RO and hot

disinfection system

Water costs

Energy costs

Service and maintenance

TCO

Average cost structure

24%

25%

24%

The savings potential by…

► Reduced Water Consumption

► Reduced Energy costs

► Reduced effort in disinfection,

(cleaning) and system service

…can reduce the lifetime costs to a

minimum and makes it even possible

to reach ROI.

Capital costs

RO and hot

disinfection

system


24%

Reduction in water costs:

TCO

Impulse back washing feature keep membranes clear. Constant amount of water can pass the

membrane.

Double stage RO system further reduces water discharge

Highest recovery rate of 85% (double stage RO)

40% less water

consumption than

conventional

systems.

$-

$5,000.00

$10,000.00

$15,000.00


$0.00

$1,000.00

$2,000.00

Conventional Tank System

Aquaboss Hot Rinse Smart

Reduction in energy costs:

TCO

Flow through heater ensure continuous recirculation and only heats up permeate only during

hot disinfection. This means: no constant heating of a large water reservoir.

More than 90%

less electricity

consumption

compared to tank

systems during

heat disinfection.

25%


$-

$5,000.00

$10,000.00

$15,000.00

Total cold disinfection

Cold RO / Hot loop disinfection

Total Hot disinfection

The system Multiple sources to reduce total cost of ownership

► Reduced effort in disinfection procedures

TCO

Automatic heat disinfection reduces labor and eliminates the need to test for the presence

of disinfectants.

60% (40%)

less cost for

system

disinfection.

24%

$-

$10,000.00

$20,000.00

$30,000.00

Conventional System Aquaboss

► Reduced Labor Costs

TCO

Impulse back washing increases membrane life while maintaining a consistent water

recovery rate.

More than

55% less

membrane service

related costs.

24%


Conventional

System

Investment

Water cost per year

Energy cost heat disinfection

Disinfection procedures

Cost advantage per year

Savings

$150,000 $120,000

$1.12 per 100 gal progressive calc

$12,254 $20,835

$10 $1,994

$5,376 $9,096

>40%

>90%

>40%

> $14,000

Sum $17,640 $31,925

>43%

Return on investment is less than 3 years! Impulse back washing savings is not included in the ROI

calculation.

(25%)

De novo installation

Summary

► Higher treatment quality by higher water quality

► Lower risk of residual disinfectants in RO and ring piping system.

► More effective technology for preventing biofilm.

► Additional savings potential from Impulse back washing function

► Full flexibility in system capacity and features. Later upgrade

possibilities means no invest in unused over capacities.

► Fully automated end to end thermal disinfection

► The innovative Aquaboss Vision monitoring software.

Aquaboss Vision monitoring software/Process

Visualization & Optimization

Visualization of operating parameters.

Status and digital reading (and display) of

all sensors.

Log file exchange file to track the

operation status online for quick fault

finding and error prevention.

Disinfection history storage

► Thus Aquaboss Vision helps to provide cost-effective maintenance as well as an

optimized and paperless process for the user.

Vision Monitoring Software

EcoRO Dia I/II Flow Diagram

Status of RO

Digital Signals

Pressure

Temperature

Flow

Option III: Premium An ultimate carefree package that provides maximum security.

It includes preventive maintenance, spare parts and on site

technical support under one standard cost. (see details on next

slides)

Option II: Advanced Team The advanced package covers all service parts and

on-site support on a second level basis. It includes

all advantages of the preventive maintenance

package. (see details on next slides)

Option I: Preventive Maintenance Rely on the annual preventive maintenance

inspection by a B. Braun expert. Ensure top

operating performance from your dialysis

equipment and increase productivity of your

staff. (see details on next slides)

Carefree Service Packages

Ask us for a concept of an individual system solution

that meets your specific needs and requirements.

Visit us online at:

www.bbraunusa.com [Go to: Products Renal Therapy ]

http://www.bbraunusa.com/

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